Girls DBT Program

Program Overview

Trauma-informed treatment that teaches adolescent girls how to manage their emotions and behavior.

The Devereux Massachusetts Girls Program serves females ages 13 to 22 across a continuum of settings that includes an intake unit, a cottage setting and a community group home.

The primary diagnostic features of our clientele include symptoms of Mood Disorders, Post Traumatic Stress Disorder, Reactive Attachment Disorder, and Borderline Personality Disorder. The Girls Program can also accommodate a subset of adolescents within the Pervasive Developmental Disorders spectrum. In addition, our clients typically exhibit self-harming behaviors, such as cutting. Many of the girls referred to Devereux have co-occurring mental health and substance abuse disorders.

The Devereux Program has modified standard adult Dialectical Behavior Therapy (DBT) for use with adolescent females. This treatment modality is effective for reducing emotion dysregulation and accompanying incidents of self harming behaviors. For girls with substance abuse problems, the program also integrates substance abuse-specific treatment (e.g., attendance at 12-step meetings, participation in psychoeducation and relapse prevention groups) into the DBT model.

Admission Criteria

The Devereux Massachusetts residential treatment program is appropriate for female adolescents who meet the following criteria:

Age 13 to 21

Mild intellectually disabled to above average intelligence range

A diagnosed mental health disorder

Co-occurring disorders of substance abuse and mental health

Impairment that interferes with the adolescent’s functioning in family, school, and the community

Admissions Procedure

Mission Statement

The mission of the Devereux Massachusetts Girls Residential Treatment Program is to teach clients the skills they need to function as independently as possible in a setting that is safe, predictable, and empathic. We reach out to families, involve them in their child’s treatment, and support them in caring for their child.

Program Objectives

The goals are to help girls improve in the following areas:

Ability to regulate the expression of emotions.

Ability to control impulses.

Acquiring social skills necessary to form positive peer and adult relationships.

Identifying triggers related to substance use as well as strategies for relapse prevention.

Improving relationships within the family.

Reintegrating into the community with skills which will allow functioning with minimal supervision.

Treatment Components

The treatment program includes each of the standard DBT modes of treatment:

Individual Therapy: Each girl in the program receives individual therapy by a DBT intensively trained clinician at least once per week where they review progress on target behaviors, conduct behavioral chain analysis on ongoing problems, learn and rehearse positive replacement skills, and discuss other relevant concerns. Clinicians recognize that the quality of their treatment relationship with a client can profoundly impact the treatment progress, and they make themselves available for consultation in person or over the phone when a client is in crisis and needs skills coaching.

DBT Skills Training Groups occur on each of the girls’ residences one time per week. These groups are co-led by an intensively trained DBT clinical staff and a trained residential staff member. Groups typically have 6-8 clients and run for a total of 26 weeks focusing on each module. The modules are: Mindfulness Skills, Interpersonal Effectiveness Skills, Emotion Regulation Skills, and Distress Tolerance Skills. Clients are taught a new skill each week that is reinforced and coached throughout the week by staff and clinicians alike. DBT language and mindfulness exercises are woven throughout all skills groups.

Skills Coaching Conducted in Informal Settings (the ‘24/7 approach’): Skills Coaching is an integral aspect of the milieu. Residential staff are available “in the moment” to coach DBT skills, suggesting what skills can be used, how they can be used, and when they should be used. Staff prompt clients to use these replacement skills whenever relevant situations arise during the course of the day. The staff also make use of these “teachable moments” by first validating the client’s current experience, then suggesting an alternative way of handling the situation, and finally reinforcing the client’s attempts to perform the new skill.

DBT Diary Cards are completed once per day on the residential unit. The diary cards are then reviewed by both a staff member and the client. Encouraging clients to review their diary cards with the staff the same day allows immediate feedback, praise, validation, and coaching. These diary cards also are reviewed at the start of each individual therapy session consistent with standard DBT treatment.

Daily Group Meetings are held every day. In this group, girls are prompted to reflect upon their skill use during the day. In addition, the girls are encouraged to identify skills they noticed each other using during the day.

DBT Consultation Team is comprised of clinical staff and meets once per week for a two hour period. Consultation team serves as a regular forum for clinicians to review challenging sessions with clients, role-play successful interactions, and address burnout.

“Chill out” rooms are located on the intake unit and the cottage. These are rooms where girls can physically use their skills. Clients are encouraged or coached to use this room to take space from a situation until they become more emotionally regulated. This room has beanbag chairs, blankets to wrap up in, and other objects contained in each client’s self-soothing box to help them cope with distress.

Substance Abuse Treatment
Numerous support groups such as Alcoholics Anonymous and Narcotics Anonymous are offered on a weekly basis. In addition, the Girls Program provides substance abuse psychoeducation and relapse prevention groups. These are designed to educate clients about substance abuse issues and reinforce motivation to strive for a substance free lifestyle.

Relational Approach
Positive relationships between clients and staff are the most important factor in creating a treatment environment that is safe, warm, predictable, empathetic, and helps clients feel competent and successful. All learning occurs in the context of relationships and behavior change techniques are most effective when they are employed in the context of a positive relationship.

We believe that positive change can occur through clients experiencing connection with staff. Engagement, connection, and relationships with competent, caring adults are therapeutic. Staff are teachers and role models who demonstrate genuine interest in and respect for their clients. They respond to each client as a unique individual and are attuned to her feelings.

Positive Behavior Support
Positive behavioral support is an approach that emphasizes teaching skills as a central behavior change tool and focuses on replacing coercion with environmental redesign to achieve durable change. Problem behavior is viewed as the result of a client trying to meet a need without having the skills to meet that need appropriately. It may be an attempt to escape or avoid overwhelming feelings of pain or shame. Accordingly, the role of treatment is to teach the skills required so that the girl can meet her needs in more appropriate and successful ways.

Groups
In addition to DBT and Substance Abuse groups, a number of mental health groups are offered in the residences, such as Anger Management, Social Skills Training, Relaxation Groups, and Self Esteem Groups. The primary function of these groups is to teach girls new skills in order to help them deal with their mental health issues.

Family Involvement
It is widely believed and supported that family involvement plays a key role in the success of the treatment outcome. We believe that the parents/responsible adults in an adolescent's life are experts about their children and their knowledge must be incorporated into assessment and treatment. We understand that parents need support, education, and skills to relate to their adolescents in more satisfying ways.

"When I first came to Devereux, I used to put myself down. Now I have more confidence in myself. I know if I put my mind to it, I can achieve my goals." -- Alyssa, 16